Key Facts
MassHealth (Medicaid) in Massachusetts
Massachusetts was the pioneer of healthcare reform in the United States. The state implemented comprehensive healthcare reform in 2006 under Governor Mitt Romney, which served as the model for the Affordable Care Act. MassHealth provides extensive coverage options for low-income residents.
MassHealth Programs
- MassHealth Standard: Full Medicaid benefits for eligible individuals and families
- MassHealth CarePlus: Coverage for adults 21-64 with incomes up to 138% FPL
- MassHealth Family Assistance: Coverage for children and families at higher income levels
- MassHealth Limited: Emergency services for those not eligible for full benefits
Who Qualifies for MassHealth?
- Adults ages 19-64 with income up to 138% FPL ($20,783/year for individuals)
- Pregnant women with income up to 200% FPL
- Children under 19 with income up to 300% FPL
- Seniors and people with disabilities meeting income and asset requirements
- Parents/caretakers meeting income requirements
MassHealth Benefits
- Preventive care and wellness visits
- Doctor visits and specialist care
- Hospital inpatient and outpatient services
- Prescription drug coverage
- Mental health and substance abuse treatment
- Dental services (MassHealth Dental)
- Vision care
- Laboratory and X-ray services
- Rehabilitation services
How to Apply
You can apply for MassHealth through:
- Online at MAhealthconnector.org
- By phone: 1-800-841-2900
- In person at a MassHealth Enrollment Center
- Through a certified application counselor or navigator
Massachusetts Health Connector
The Massachusetts Health Connector was established in 2006, predating the ACA marketplace by several years. It serves as the model for state-based exchanges and offers comprehensive health insurance options for individuals, families, and small businesses.
Available Plan Types
- Bronze: Lower premiums, higher out-of-pocket costs (60% coverage)
- Silver: Moderate premiums and costs (70% coverage) - best for subsidies
- Gold: Higher premiums, lower out-of-pocket costs (80% coverage)
- Platinum: Highest premiums, lowest out-of-pocket costs (90% coverage)
Individual Mandate
Massachusetts maintains its own individual mandate requiring most residents to have health insurance. Those without coverage may face a tax penalty when filing their state income taxes. This mandate has contributed to Massachusetts having the lowest uninsured rate in the country.
Enrollment Periods
Open Enrollment: November 1, 2024 - January 23, 2025
MassHealth accepts applications year-round. You can also qualify for a Special Enrollment Period on the Health Connector if you have a qualifying life event.
Average Costs in Massachusetts
Health insurance costs in Massachusetts are among the highest in the nation due to the high cost of living and concentration of major medical centers. However, subsidies and ConnectorCare significantly reduce costs for many residents. Here are typical monthly premiums before subsidies:
| Plan Type | Individual (Age 40) | Family of 4 |
|---|---|---|
| Bronze | $350 - $420 | $1,100 - $1,400 |
| Silver | $440 - $540 | $1,400 - $1,750 |
| Gold | $510 - $610 | $1,600 - $2,000 |
| MassHealth | $0 | $0 |
Frequently Asked Questions
Has Massachusetts expanded Medicaid?
Yes, Massachusetts was a pioneer in health care reform and had expanded coverage even before the ACA. Adults with household incomes up to 138% of the Federal Poverty Level qualify for MassHealth Standard.
What is Health Connector?
Massachusetts Health Connector is the state's health insurance marketplace where residents can shop for and enroll in qualified health plans. It predates the ACA and was a model for the federal marketplace.
Does Massachusetts require health insurance?
Yes, Massachusetts has an individual mandate requiring residents to have health insurance if affordable coverage is available. Those without coverage may face a tax penalty when filing state taxes.
What is MassHealth?
MassHealth is Massachusetts' Medicaid and CHIP program providing free or low-cost health coverage to eligible residents. It includes MassHealth Standard, CarePlus, and other coverage options based on income and eligibility.
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